Neurosurgeons: Upfront on Concussions’

Guest post from Hunt Batjer, MD
Lois C. A. and Darwin E. Smith Distinguished Chair in Neurological Surgery
UT Southwestern Neurosurgery Department
Dallas, TX

Football-big-thumbProfession football is the most popular sport in the US. This popularity is growing despite increasing publicity over the impact of concussions and the potential for long term health consequences of the game. Neurosurgery is the specialty that has always been devoted to the diagnosis and treatment of all sports-related concussions. Our specialty has been leaders in the scientific and clinical research on this crucial public safety concern in addition to driving policy and organizing national and international programs for prevention through Think First.

Recently, the Los Angeles Times reported on a high profile study that directly tested the value of preventing concussions by 10 widely used helmets casting a long shadow on current designs. Unfortunately, there is no commercially available concussion-proof football helmet. One could be designed very quickly that would meet the standard (of preventing concussions) but would have the unfortunate complication of creating a large number of cervical spine injuries. The authors correctly challenge the National Operating Committee for Standards In Athletic Equipment (NOCSAE) standard as not being protective against concussive type blows. The test standard was developed (anvil drop) to prevent catastrophic device failure, skull fracture, subdural hematoma, and death. This standard drove the manufacturers toward the shell helmet that is used today. There are substantial opportunities for improvement in this design using contemporary mechanical engineering principles and materials sciences.

It is crucial to remember, however, that in addition to helmet design, there are many other factors that must be considered including helmet fit, proper conditioning of the athlete, proper coaching, and rigorous enforcement of the rules.

One very important and exciting area of research is gaining a better understanding of the impact of rotational acceleration. This year the NFL has validated three accelerometer devices in two independent laboratories and performed the first on field pilot study. Over 11,000 impacts were measured in this small pilot. Hopefully improvement in these devices, particularly in the rotational analysis, will allow a better appreciation for the types of impacts that result in clinical concussions.

Neurosurgeons also want to emphasize a critcal lesson which must be learned from motor sports, downsizing an adult helmet to fit a child does not in fact impart optimal protection. This is another concern of neurosurgery advocacy, approached directly with close dialogue with NOCSAE.

Given the rising popularity of the game, improving player safety, for the youngest to the professional football player is a complicated and challenging undertaking, but is one that must be given priority. Organized neurosurgery remains at the cutting edge on many fronts on this issue:

  • Improving our understanding of sports-related head injury
  • Collaborating on equipment design and testing
  • Supporting high value prevention  and public awareness programs
  • Insuring standards in the evaluation, treatment and return to play of those sustaining concussions

Neurosurgeons are where you need them:  Upfront on concussion, helping to keep brains healthy.

Additional Information:

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House Passes Bill to Repeal the SGR; Attention Now Turns to the Senate

1236756_10201843651315115_1054821300_nOn March 14, 2014, by a vote of 238 to 181, the U.S. House of Representatives passed legislation to repeal Medicare’s sustainable growth rate (SGR) physician payment system. The “SGR Repeal and Medicare Payment Modernization Act” (H.R. 4015), establishes a new streamlined value-based incentive payment system called the Merit-Based Incentive Payment System, or MIPS. The new program consolidates the three existing Medicare incentive programs — Physician Quality Reporting System (PQRS), Electronic Health Records (EHR) and Value-Based Payment Modifier (VBPM) — and allows physicians to opt-out of the fee-for-service system in favor of participating in alternative payment models (APMs), such as accountable care organizations, patient-centered medical homes and other similar arrangements.

The bill, with a $138 billion price tag, was paid for with a 5-year delay of the Affordable Care Act individual mandate to purchase health insurance — a move that democrats charged was a partisan budgetary off-set and resulted in few democrats voting in favor of the legislation. The AANS and CNS did not take a position on the budget off-set debate.

Because it met many of neurosurgery’s core principles, neurosurgery previously supported passage of the bill, although we also pointed out ongoing concerns with several aspects of the legislation.

Attention now turns to the U.S. Senate, where procedural steps have been taken to allow the Senate to consider two versions of the “SGR Repeal and Medicare Payment Modernization Act” — S. 2110, introduced by Sen. Ron Wyden (D-Ore.) and S. 2122, introduced by Sen. Orrin Hatch (R-Utah). The only difference between these two bills is the basis on which they would be paid. Sen. Wyden’s version does not include any budgetary offsets, and if passed, would add the cost of repeal to the nation’s budget deficit.  The Congressional Budget Office (CBO) estimates this version will cost $180.2 billion over 11 years. In contrast, Sen. Hatch’s version includes a permanent repeal of the individual mandate to purchase health insurance as a mechanism to pay for SGR repeal, which will produce a net budgetary savings.

If Congress fails to act by the end of March, physicians face a 24 percent Medicare pay cut on April 1, 2014. It is unlikely, however, that this cut will go into effect and as Congress reportedly is also working on a temporary “patch” so work can continue on a permanent solution.

Posted in Access to Care, Coding and Reimbursement, Congress, Health, Medicare, Quality Improvement, SGR | Tagged , , , , |

New Study Shows ICD-10 Implementation Costs to Be Significantly Higher

New cost estimates for implementing the federally mandated ICD-10 code set by Oct. 1, 2014, are, in some cases, nearly three times more than previously estimated, according to a new study released by the American Medical Association (AMA).

ICD10Costs associated with ICD-10 implementation include training, vendor and software upgrades, testing and payment disruption. Compared to a similar study completed in 2008, these costs could be as much as $8 million for a typical large physician practice. For a small practice, implementation costs could be more than $225,000. The move is expected to be “much more disruptive for physicians” than previous mandates.

“The markedly higher implementation costs for ICD-10 place a crushing burden on physicians, straining vital resources needed to invest in new health care delivery models and well-developed technology that promotes care coordination with real value to patients,” AMA President Ardis Dee Hoven, MD, said in a news release.

“Continuing to compel physicians to adopt this new coding structure threatens to disrupt innovations by diverting resources away from areas that are expected to help lower costs and improve the quality of care,” Dr. Hoven said.

Current cost estimates are higher now “due to the need for testing, and the potential for increased payment disruption,” the study reports. “A major element in cost is clearly the vendor/software upgrade category.”

The study notes specialty practices will see the highest ICD-10 implementation costs, especially in productivity losses and payment disruptions, because of their higher revenues and per hour rates.

The study estimates both pre- and post-ICD-10 implementation costs for average small, medium and large physician practices. While conservative cost estimates fall slightly below 2008 estimates, the range of expenses is much higher than the AMA’s 2008 analysis, and many practices are expected to fall into the higher ranges.

Although organized neurosurgery is still advocating that Medicare scrap this new coding system, we recognize that it is imperative that neurosurgeons are nevertheless prepared for the change — particularly since significant disruption to claims processing is almost certain and the agency will not provide any transition period.  To access educational resources for practical insight into the preparation process, click here.

These numbers are too important to ignore. Share on social media, and help us #StopICD10. Share on Facebook. Share on Twitter.

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